Public (owing a duty of care)

The National Health Service Act 1977 charges the Secretary of
State with a duty to provide healthcare to the public.
Healthcare professionals by virtue of their relationship with the
patient and their employment within the NHS owe a duty of care to
the patient. A duty of care is expected of all practitioners
and is both a professional and legal obligation. Both
professional misconduct hearings and legal actions can arise from
failure in a duty of care.

As an advanced practitioner the care owed to the patient would
be that reasonably expected of any ordinary healthcare professional
practising at that level and professing to have that particular
skill set. The Bolam test
has traditionally been the legal standard for clinical negligence
cases. See Standard of Care, Clinical Negligence Case studies
including Bolam V Friern Hospital Management
Committee in the
resources section.

The Bolam test has previously been used to judge medical
practice but would apply to all healthcare professionals.
Negligence is determined by whether the healthcare professional
acted in accordance with accepted practice as recognised by a
responsible body of professional opinion. More recent cases
e.g. Bolitho v City and Hackney Health Authority have held
that the professional opinion should be logically defensible.

A duty of care encompasses avoiding actions and omissions that
are reasonably likely to cause harm to the patient. The legal
test of a duty of care was established in the case of Donoghue
v Stevenson, Lord Atkin stated:-

"You must take reasonable care to
avoid acts or omissions which you can reasonably foresee would be
likely to injure your neighbour".

A duty of care exists as part of the contract of employment in
the NHS. This duty of care is owed in delict
or tort as there is no direct contractual agreement between
the patient and practitioner. Should a patient consult an
advanced practitioner privately action may be possible against the
individual within the realms of contractual law.

The question of whether nurses are obliged to provide assistance
to the public outwith their employment and at all times is less
clear. Legally, healthcare professionals are obliged to
provide care to patients in an emergency situation outwith their
work environment if they have an existing professional relationship
with the individual or they have created the situation which
resulted in harm to the individual (
NMC, 2008).

From a professional perspective, nurses remain accountable for
their actions and have a
professional duty to provide care. The standard of care
expected in such a situation would be that which could be
reasonably expected from any health care professional with their
knowledge, skills and experience.